Americans Are Divided About Health Reform Proposals Overall, But the Public Becomes More Supportive When Told About Key Provisions

A new Kaiser Family Foundation poll finds that Americans are divided over congressional health reform proposals, but also that large shares of people, including skeptics, become more supportive after being told about many of the major provisions in the bills.

The January Kaiser Health Tracking Poll, conducted before the Massachusetts Senate vote, finds opinion is divided when it comes to the hotly debated legislation, with 42 percent supporting the proposals in the Congress, 41 percent opposing them and 16 percent withholding judgment. However, a different and more positive picture emerged when we examined the public’s awareness of, and reactions to, major provisions included in the bills. Majorities reported feeling more favorable toward the proposed legislation after learning about many of the key elements, with the notable exceptions of the individual mandate and the overall price tag.

For example, after hearing that tax credits would be available to small businesses that want to offer coverage to their employees, 73 percent said it made them more supportive of the legislation. Sixty-seven percent said they were more supportive when they heard that the legislation included health insurance exchanges, and 63 percent felt that way after being told that people could no longer be denied coverage because of pre-existing conditions. Sixty percent were more supportive after hearing that the legislation would help close the Medicare “doughnut hole” so that seniors would no longer face a period of having to pay the full cost of their medicines. Of the 27 elements of the legislation tested in the poll, 17 moved a majority to feel more positively about the bills and two moved a majority to be more negative.

In some cases elements of the legislation were popular enough to prompt a majority of skeptics to soften their opposition, including the tax credits for small businesses (62% of current opponents said it made them more supportive), the fact that most people’s existing insurance arrangements would not change (59%), and the stipulation that no federal money would go to abortion (55%).

A smaller number of provisions cut the other way. When told that nearly all Americans would be required to have health coverage, for instance, 62 percent of people said it made them less likely to support the legislation and 51 percent said they were less likely to support the reform package after learning it will cost at least $871 billion over 10 years.

“It’s one thing to talk about the public’s perception of health care reform legislation, which right now is in some ways negative, but it’s another to tell people what’s actually in the bill and when you do that people are more positive,” said Kaiser President and CEO Drew Altman.

The poll finds that even after a year of substantial media coverage of the health reform debate, many Americans remain unfamiliar with key elements of the major bills passed by the House and Senate. About half are aware that tax credits would be available to small businesses, one of the most popular provisions. And 44 percent recognize that the legislation would help close the Medicare “doughnut hole.”

Awareness can matter. Among the least known elements of the bills, those with the biggest potential to change minds include the fact that the Congressional Budget Office has said health reform would reduce the deficit (only 15% expect the legislation to reduce the deficit, but 56% said hearing that makes them more supportive) and that the legislation would stop insurers from charging women more than men (37% are aware that the legislation would do this, but 50% said this provision makes them more supportive). There were no lesser known provisions that would push a majority of supporters away from the bill.

Independents Occupy The Middle Ground In the Debate

Americans’ views of health reform generally track with their politics: Most Democrats (64%) support the proposals on Capitol Hill, while an even larger majority of Republicans (76%) oppose them. The middle ground is left to independents, with 41 percent in favor and 43 percent opposed- even as a narrow majority (52%) backs the general idea that it is more important than ever to take on health reform now.

As with the public overall, independents say the elements most likely to push them in the direction of supporting the legislation include the tax credits for small businesses (74%); the insurance exchanges (69%); and the stability in coverage for most people with employer-sponsored plans (66%). Similarly, they are turned off by the individual mandate (67% say this makes them less supportive) and the overall cost of health reform (57%).

Independents do differ in some ways from those with declared partisan leanings. They are much more likely than Republicans to say that they feel more supportive of the legislation because it would provide coverage for the uninsured (61% of independents compared to 22% of GOP members). And they are more concerned than Democrats about the bills’ multi-billion dollar price tag; 57 percent of independents say the cost makes them feel less supportive, compared to 34 percent of Democrats.

Many Seniors Are Unaware of Effort To Close The Medicare “Doughnut Hole”

The new survey finds that America’s seniors, a politically important group, lean against the proposed legislation, with 48 percent opposed, 37 percent in favor and 15 percent offering no opinion. However the survey finds that, somewhat surprisingly, seniors were less likely than younger Americans to be aware that the legislation includes provisions to close the “doughnut hole.” Thirty-seven percent of seniors were aware of such provisions, compared to 53 percent of those under age 40. Six in 10 seniors say that if the legislation did work to close the doughnut hole they would feel more supportive of it, a level of support identical to that found among younger Americans.

There is a generational split, however, on proposals that would limit future increases in some Medicare provider payments. Younger Americans favor such measures by almost a 2-to-1 margin while the opposite is true of seniors.

Methodology

The survey was designed and analyzed by public opinion researchers at the Kaiser Family Foundation and was conducted January 7 through January 12, 2010, among a nationally representative random sample of 2,002 adults ages 18 and older. Telephone interviews conducted by landline (1,350) and cell phone (652, including 255 who had no landline telephone) were carried out in English and Spanish. The margin of sampling error for the total sample is plus or minus 3 percentage points. The questions about specific elements of health reform legislation were asked of random quarter-samples of respondents, and for these questions the margin of sampling error is plus or minus 5 percentage points. For results based on subgroups, the margin of sampling error is higher.

The full question wording, results, charts and a brief on the poll can be viewed online.

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